Provider Demographics
NPI:1679643530
Name:SMITH, WAYNE S (DC)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301
Mailing Address - Country:US
Mailing Address - Phone:509-547-1759
Mailing Address - Fax:
Practice Address - Street 1:1211 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-547-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020519Medicaid
WA0005162299OtherAETNA
WA146894146896OtherPREMERA BLUE CROSS
WA911678952F001OtherPREMERA BLUE CROSS FEP
WA36281OtherLABOR & INDUSTRIES
WA653633OtherACN
WA93621468940001OtherPREMERA BC NASCO
U47867Medicare UPIN